Provider Demographics
NPI:1407098064
Name:BURK, GARY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
Last Name:BURK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 E MENLO ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-1685
Mailing Address - Country:US
Mailing Address - Phone:480-390-1824
Mailing Address - Fax:480-247-3516
Practice Address - Street 1:2837 E MENLO ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-1685
Practice Address - Country:US
Practice Address - Phone:480-390-1824
Practice Address - Fax:480-247-3516
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-28
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC5007111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition